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05 December 2022 : Case report  USA

[In Press] Giant-Cell Aortitis-Induced Acute Aortic Insufficiency: An Underestimated Etiology

Challenging differential diagnosis, Rare coexistence of disease or pathology

Muhammad Atif Masood Noori1AE, Mahsa Mohammadian1F, Hasham Saeed1EF, Jesus Romero1E, Jesani Shruti1E, Hardik Fichadiya1E, Sherif Elkattawy1E, Qirat Jawed1E, Dhaval Shah2F, Kalpesh K. Shah2E, Ioannis Loumiotis3DEF, Meherwan B. Joshi1DEF, Bille Fyfe4E

DOI: 10.12659/AJCR.937836

Am J Case Rep In Press; DOI: 10.12659/AJCR.937836  

Available online: 2022-12-05, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Acute aortic insufficiency can be secondary to multiple conditions, including infective endocarditis, aortic root pathologies (eg, dissection, aortitis), or traumatic injury. Aortitis involves a broad spectrum of disorders characterized by inflammatory changes in the aortic wall. This pathology can be subsequently classified depending on its etiology into inflammatory and infectious causes. Large-vessel vasculitis (giant-cell arteritis, Takayasu arteritis, and IgG4-related vasculitis) is the most common non-infectious causes of aortitis. Giant-cell aortitis usually lacks the classic clinical findings of giant-cell arteritis such as headache, visual symptoms, or jaw claudication, which can be a diagnostic challenge. However, clinicians should have a high index of suspicion, since this pathology can evolve into potentially life-threatening conditions, including aortic aneurysm, aortic wall rupture, and aortic acute dissection.
CASE REPORT
We present a case of a 76-year-old woman who presented to the Emergency Department (ED) with shortness of breath associated with orthopnea, paroxysmal nocturnal dyspnea, and mild productive cough with white sputum. A transthoracic echocardiogram demonstrated reduced left ventricular ejection fraction, dilated left ventricle, and severe aortic insufficiency. Cardiac catheterization revealed mild non-obstructive coronary arteries and severe aortic regurgitation. The surgical pathology report of the portion of the aorta was consistent with giant-cell aortitis.
CONCLUSIONS
In this article, we present a case of giant-cell aortitis as an unusual etiology of acute aortic insufficiency, which is most probably under-detected in clinical practice. In addition to describing the case, we aim to highlight the importance of proper ascending aorta evaluation in patients presenting with new-onset aortic regurgitation and heart failure to prevent associated morbidity and mortality.

Keywords: Aortic Valve Insufficiency; Aortitis; Giant Cell Arteritis; Heart Failure

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923